There are no official guidelines to assist in answering this question. I will search for relevant research papers instead.
From the Research
Management of Malignant Otitis Externa
The management of malignant otitis externa (MOE) in patients with Diabetes Mellitus (DM) involves a combination of treatments, including:
- Control of diabetes mellitus 1, 2
- Antibiotic therapy, with the most common pathogen being Pseudomonas aeruginosa 1, 2, 3
- Debridement of necrotic tissue 1, 3
- Surgical management, which may include facial nerve decompression 1, 2
- Hyperbaric oxygen therapy, which has shown promise in the treatment of MOE 3, 4
Factors Affecting Patient Outcomes
Several factors have been identified as predictors of poor outcome in patients with MOE, including:
- Presence of diabetes mellitus 2
- Facial nerve palsy 2
- Positive CT scan 2
- Age above 70 years 2
- Presence of two or more of these factors 2
Treatment Modalities
Different treatment modalities have been used in the management of MOE, including:
- Intravenous antibiotics 1, 2, 3
- Limited surgery 3
- Hyperbaric oxygen therapy 3, 4
- Antifungal therapy, in cases of fungal malignant external otitis 5
Importance of Early Diagnosis and Treatment
Early diagnosis and treatment of MOE are crucial to prevent complications and improve patient outcomes 1, 2, 3. A high index of suspicion is necessary to diagnose MOE, especially in diabetic patients with persistent ear discharge and otalgia 1, 2.